NPIMap

Individual provider Active NPI

Daniel Robert Smith, M.D.

  • Family Medicine Physician
  • Saint Cloud, MN
National Provider Identifier
1972588150
Registry record updated Mar 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
41725 Issued in MN
Practice address
1520 Whitney CT
Centra Care Clinic
St Cloud, MN 56303-1899
Phone
(320) 251-1755
Fax
(507) 434-1477
NPI assigned
Dec 12, 2005
Last updated
Mar 7, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 41725 MN Primary

Addresses

Primary practice location

1520 Whitney CT
Centra Care Clinic
St Cloud, MN 56303-1899

Mailing address

1520 Whitney CT
Centra Care Clinic
St Cloud, MN 56303-1899
Phone (320) 251-1755

Other identifiers 2

IdentifierTypeStateIssuer
340757800MedicaidMN
080140250OtherMNMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100420000788 MN Practitioner - Family Practice 1951438167 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Creighton University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1900 Centracare Cir
Saint Cloud, MN 56303-5000
Phone (320) 654-3630

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions14
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
7730MNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic Current Accepting new patients
Centracare Clinic CurrentSince Mar 1, 2020 Accepting new patients
Centracare Clinic CurrentSince Mar 1, 2020 Accepting new patients

Locations

12800 Rolling Ridge Rd
Becker, MN 55308
Phone (763) 261-7000

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1520 Whitney Ct
Saint Cloud, MN 56303
Phone (320) 240-3160

1555 Northway Dr
Ste 100
Saint Cloud, MN 56303
Phone (320) 240-3114

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

Interoperability endpoints

  • Direct secure messaging: dsmith32423@direct.centracare.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331078400000",
    "number": "1972588150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 WHITNEY CT",
            "address_2": "CENTRA CARE CLINIC",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563031899",
            "telephone_number": "320-251-1755",
            "fax_number": "507-434-1477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 WHITNEY CT",
            "address_2": "CENTRA CARE CLINIC",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563031899",
            "telephone_number": "320-251-1755",
            "fax_number": "507-434-1477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "DANIEL",
        "middle_name": "ROBERT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-12",
        "last_updated": "2012-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "41725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "340757800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "080140250",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.